Article

Allergic Disease and Atopic Sensitizatin in Children Related to Farming and Anthroposophic Lifestyle—The PARSIFAL Study

Wiley
Allergy
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Abstract

The prevalence of allergic diseases has increased rapidly in recent decades, particularly in children. For adequate prevention it is important not only to identify risk factors, but also possible protective factors. The aim of this study was to compare the prevalence of allergic diseases and sensitization between farm children, children in anthroposophic families, and reference children, with the aim to identify factors that may protect against allergic disease. The study was of cross-sectional design and included 14,893 children, aged 5-13 years, from farm families, anthroposophic families (recruited from Steiner schools) and reference children in Austria, Germany, The Netherlands, Sweden and Switzerland. A detailed questionnaire was completed and allergen-specific IgE was measured in blood. Growing up on a farm was found to have a protective effect against all outcomes studied, both self-reported, such as rhinoconjunctivitis, wheezing, atopic eczema and asthma and sensitization (allergen specific IgE > or = 0.35 kU/l). The adjusted odds ratio (OR) for current rhinoconjunctivitis symptoms was 0.50 (95% confidence interval (CI) 0.38-0.65) and for atopic sensitization 0.53 (95% CI 0.42-0.67) for the farm children compared to their references. The prevalence of allergic symptoms and sensitization was also lower among Steiner school children compared to reference children, but the difference was less pronounced and not as consistent between countries, adjusted OR for current rhinoconjunctivitis symptoms was 0.69 (95% CI 0.56-0.86) and for atopic sensitization 0.73 (95% CI 0.58-0.92). This study indicates that growing up on a farm, and to a lesser extent leading an anthroposophic life style may confer protection from both sensitization and allergic diseases in childhood.

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... This increase is probably linked to major societal and environmental changes, such as industrial development and air pollution (4). Moreover, lifestyles, living environments, and exposure to chemical hazards, such as pesticides, in early life seem related to allergic sensitization, eczema, and asthma later in life (5)(6)(7)(8)(9)(10). ...
... In the Norwegian Mother and Child Cohort Study (MoBa) study, frequent consumption of organic vegetables during pregnancy was associated with reduced risk of pre-eclampsia for the mother and hypospadias in offspring (12,13). Studies conducted in anthroposophic communities suggest that OF consumption may have a protective effect on allergies and atopy (5,6,10,11,14), even if distinguishing the role of OFs from that of other factors linked to anthroposophic lifestyles was difficult (5,10). ...
... In the Norwegian Mother and Child Cohort Study (MoBa) study, frequent consumption of organic vegetables during pregnancy was associated with reduced risk of pre-eclampsia for the mother and hypospadias in offspring (12,13). Studies conducted in anthroposophic communities suggest that OF consumption may have a protective effect on allergies and atopy (5,6,10,11,14), even if distinguishing the role of OFs from that of other factors linked to anthroposophic lifestyles was difficult (5,10). ...
Article
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Objectives: To assess (1) whether a history of allergy is associated with feeding with organic foods (OFs) during the complementary feeding period and (2) whether OF consumption in infancy is related to the incidence of respiratory and allergic diseases up to age 5.5 years. Study Design: Analyses involved more than 8,000 children from the nationwide Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort. Associations between family or infant history of allergy and frequency of OF consumption during the complementary feeding period were assessed with multinomial logistic regression. Associations between OF consumption in infancy and respiratory or allergic diseases between age 1 and 5.5 years were assessed with logistic regression. Results: A family history of allergy or cow's milk protein allergy at age 2 months was strongly and positively related to feeding with OF during the complementary feeding period. Feeding with OF during the complementary feeding period was not related to respiratory diseases or eczema up to age 5.5 years. Compared to infrequent consumption of both organic and commercial complementary foods, frequent OF consumption without commercial complementary foods was associated with a higher risk of food allergy, whereas frequent commercial complementary food consumption without OF use was associated with a lower risk of food allergy. Conclusions: This study suggests that a history of allergy strongly affects feeding with OF during the complementary feeding period. However, OF consumption was not associated with reduced odds of food allergy later in childhood but could be associated with increased odds, which should be examined more deeply.
... Previous research on the respiratory health of Swiss children focused on self-reported lower respiratory symptoms and a farming environment [8][9][10][11][12][13][14]. None of the recent population-based studies included a detailed assessment of lung function and airway inflammation. ...
... The gas mixture had the same molar mass (MM, g.mol-1) as medical-grade air, such that any detectable changes compared with normally expired molar mass can be attributed to relative changes in helium (He) and sulphur hexafluoride (SF 6) concentrations [9]. MM was measured by a side-stream ultrasonic flowmeter, tidal flows by a main-stream ultrasonic flowmeter. ...
... Quality control of DTG-SBW measurements was performed by the field workers on site. A double check of DTG-SBW test results is on-going, to see if the phase III was linear and constituted at least 50% of expired volume [9,12]. Quality control criteria for DTG-SBW were defined as: 1) no evidence of air leaks as monitored by volume and MM signals, 2) similar flow-volume-loops in pre-test and test breaths, 3) breath volumes of the five tidal pre-test and the test breaths were within 10%, 4) inspiratory peak flow within the by-pass flow. ...
Article
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Respiratory disease is common in children and strongly associated with lifestyle and environmental exposures. Thus, it is important to study the epidemiology locally. The LuftiBus in the School (LUIS) study was set up to assess the respiratory health of schoolchildren in the canton of Zurich, Switzerland. LUIS is a cross-sectional population-based study that was carried out 2013 to 2016. Children aged 6–17 years living in the canton of Zurich were eligible to participate. All schools in the canton were approached and the school head decided whether the school would participate and with which classes. Consenting parents answered a standardised questionnaire at home and assenting children completed a shorter questionnaire by interview at school. Trained technicians measured children’s lung function, including spirometry, double tracer gas single-breath washout (DTG-SBW) and fractional exhaled nitric oxide (FeNO). Address histories of participants were geocoded to be linked with area-based socioeconomic measures and environmental exposures such as spatiotemporal air pollution estimates for specific time periods and locations. A subgroup was seen again 12 months later using the same procedures to collect longitudinal data. The study included 3870 children at baseline and 655 at the 1-year follow-up. Median age was 12.7 years; 281 (8%) had wheezed in the past year. At baseline we collected 3457 (89%) parental and 3546 (92%) child questionnaires, and 3393 (88%) FeNO, 3446 (89%) spirometry, and 1795 (46%) DTG-SBW measurements. LUIS is a rich resource of health-related data, with information on lung function, environmental exposures and respiratory health on Swiss schoolchildren.
... The European birth cohort PASTURE (Protection against Allergy: STUdy in Rural Environments), set up in the early 2000s, has focused on the protective effect of growing up on a dairy farm against Th2-driven allergic responses [5][6][7]. Up until now, several international cross-sectional studies have demonstrated that early farm exposure protects against allergic diseases, atopic sensitization, and asthma [8,9]. Early exposure during pregnancy and first years of life seems to be a window of opportunity for immune homeostasis [10]. ...
... Finally, not all farm environments protect against asthma and atopy [50]. In the past 20 years, traditional dairy farms have been studied in European cohorts to understand the specific factors of dairy farm environment involved in the protection of asthma and allergic diseases [5,8,9]. In addition to the exposure to a high endotoxin level, those studies have shown a protective effect of the consumption of raw cow's milk during pregnancy and in the first year of life [8] and also a protective effect of a diversity of early exposures [51], such as high food diversity [15] and exposure to different animal species [14]. ...
Article
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Introduction Over the past 50 years, the prevalence of allergic respiratory diseases has been increasing. The Hygiene hypothesis explains this progression by the decrease in the bio-diversity of early microbial exposure. This study aims to evaluate the effect of early-life farm exposure on airway hyperresponsiveness and cough hypersensitivity in an allergic airway inflammation rabbit model. Method A specific environment was applied to pregnant rabbits and their offspring until six weeks after birth. Rabbits were housed in a pathogen-free zone for the control group and a calf barn for the farm group. At the end of the specific environmental exposure, both groups were then housed in a conventional zone and then sensitized to ovalbumin. Ten days after sensitization, the rabbit pups received ovalbumin aerosols to provoke airway inflammation. Sensitization to ovalbumin was assessed by specific IgE assay. Cough sensitivity was assessed by mechanical stimulation of the trachea, and bronchial reactivity was assessed by methacholine challenge. The farm environment was characterized by endotoxin measurement. Results A total of 38 rabbit pups were included (18 in the farm group). Endotoxin levels in the farm environment varied from 30 to 1854 EU.m⁻³. There was no significant difference in specific IgE values to ovalbumin (p = 0.826) between the two groups. The mechanical threshold to elicit a cough did not differ between the two groups (p = 0.492). There was no difference in the number of cough (p = 0.270) or the intensity of ventilatory responses (p = 0.735). After adjusting for age and weight, there was no difference in respiratory resistance before and after methacholine challenge. Conclusion Early exposure to the calf barn did not affect cough sensitivity or bronchial reactivity in ovalbumin-sensitized rabbits. These results suggest that not all farm environments protect against asthma and atopy. Continuous exposure to several sources of microbial diversity is probably needed.
... While the growing prevalence of AD, FA, and AR continues to be a concern, several studies have suggested that not all individuals may be at risk. Initial studies from Europe [86][87][88] and America [89,90] have demonstrated an association of rural/farm living and protection against sensitization and allergy. The most recent work is highlighted in Table 3. ...
... More recently, we found a lower prevalence of FA by 12 months in OOM compared to non-farming infants; the majority of the non-farm infants with FA were allergic to egg [97]. While there are examples demonstrating the protection of the rural/farm lifestyle against AD [87,88,100], there are several observations where it appears this environment did not confer protection [86,101,102]. Inconsistencies in this relationship can be due to variability in the type of rural or farm environment, types of farm animals, as well as whether studies examined the role of the maternal prenatal effect. ...
Article
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Purpose of Review There has been an increased prevalence of allergy. Due to this relatively rapid rise, changes in environmental exposures are likely the main contributor. In this review, we highlight literature from the last 3 years pertaining to the role of air pollution, greenness, and the rural/farm lifestyle and their association with the development of allergic sensitization, atopic dermatitis, food allergy, and allergic rhinitis in infancy and childhood. Because asthma has a more complex pathophysiology, it was excluded from this review. Recent Findings Recent studies support a role for air pollution, greenness, and rural/farming lifestyle influencing atopic outcomes that continue to be defined. While many studies have examined singular environmental exposures, the interconnectedness of these exposures and others points to a need for future work to consider an individual’s whole exposure. Summary Environmental exposures’ influence on atopic disease development remains an ongoing and important area of study.
... Agronomie, 23, 1-4. Turk, M. A., Tawaha, A. M., & Shatnawi, M., (2003a Van, B. A. H., (2006) Van, D. H. M. G., (2017). Cover crops support ecological intensification of arable cropping systems. ...
... • Reduction of allergies among children (5-13) through the consumption of organic foods according to the cross-sectional PARSIFAL study by Alfvén et al. (2006) and confirmed by Stenius (2011). • Lowered risk of eczema at 2 years among babies who consumed organic daily products according to the KOALA study by Alim et al. (1999); and Kummeling (2008). ...
Chapter
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Global climate changes such as increasing CO2 levels, temperature increases, drought, etc., have been shown to adversely affect agricultural products. Weeds can be seen as a major problem because they seem to fight at the expense of the crop for resources such as light, water, and nutrients. Weed species are commonly favored in crops that are more closely associated with them. The association between weeds and crops is due to their similar growth habits. The basic strategy should be considered as the core of the organic weed control strategy: crop stand, crop rotation, crop cover, variety selection, clean seeds, soil health, soil structure, spring tillage, delayed planting, post-emergence tillage, hand weeding, mulches, and organic herbicides. This chapter focuses on: (i) classification of weed species; and (ii) weed management strategies under climate change.
... Agronomie, 23, 1-4. Turk, M. A., Tawaha, A. M., & Shatnawi, M., (2003a Van, B. A. H., (2006) Van, D. H. M. G., (2017). Cover crops support ecological intensification of arable cropping systems. ...
... • Reduction of allergies among children (5-13) through the consumption of organic foods according to the cross-sectional PARSIFAL study by Alfvén et al. (2006) and confirmed by Stenius (2011). • Lowered risk of eczema at 2 years among babies who consumed organic daily products according to the KOALA study by Alim et al. (1999); and Kummeling (2008). ...
Chapter
Azospirillum Bioinoculant Technology: Past to Current Knowledge and Future Prospects Palani Saranraj, Abdel Rahman Mohammad Al–Tawaha, Panneerselvam Sivasakthivelan, Abdel Razzaq M. Altawaha, Kangasalam Amala, Devarajan Thangadurai, and Jeyabalan Sangeetha
... Agronomie, 23, 1-4. Turk, M. A., Tawaha, A. M., & Shatnawi, M., (2003a Van, B. A. H., (2006) Van, D. H. M. G., (2017). Cover crops support ecological intensification of arable cropping systems. ...
... • Reduction of allergies among children (5-13) through the consumption of organic foods according to the cross-sectional PARSIFAL study by Alfvén et al. (2006) and confirmed by Stenius (2011). • Lowered risk of eczema at 2 years among babies who consumed organic daily products according to the KOALA study by Alim et al. (1999); and Kummeling (2008). ...
Chapter
PART III: ORGANIC AGRICULTURE FOR FOOD SAFETY 13. Organic Production Technology of Rice Shah Khalid, Amanullah, Nadia, Imranuddin, Mujeeb Ur Rahman, Abdel Rahman Al Tawaha, Devarajan Thangadurai, Jeyabalan Sangeetha, Samia Khanum, Munir Turk, Hiba Alatrash, Sameena Lone, Khursheed Hussain, Palani Saranraj, and Arun Karnwal
... Agronomie, 23, 1-4. Turk, M. A., Tawaha, A. M., & Shatnawi, M., (2003a Van, B. A. H., (2006) Van, D. H. M. G., (2017). Cover crops support ecological intensification of arable cropping systems. ...
... • Reduction of allergies among children (5-13) through the consumption of organic foods according to the cross-sectional PARSIFAL study by Alfvén et al. (2006) and confirmed by Stenius (2011). • Lowered risk of eczema at 2 years among babies who consumed organic daily products according to the KOALA study by Alim et al. (1999); and Kummeling (2008). ...
... 3,4 One of the most consistent findings of epidemiological studies conducted in different regions of the world is that children growing up on traditional farms are protected from the development of asthma and related allergies in line with the hygiene hypothesis. [5][6][7][8][9][10][11][12] Studies in Alpine regions demonstrated the strong protective effects of exposure to farm animals and consumption of farm milk against the development of asthma. [5][6][7][8] The importance of the environment was lent further support by comparative studies of two U.S. farming populations originated from Germany/ Switzerland, the Amish and the Hutterites, who share highly similar genetic background. ...
... [5][6][7][8][9][10][11][12] Studies in Alpine regions demonstrated the strong protective effects of exposure to farm animals and consumption of farm milk against the development of asthma. [5][6][7][8] The importance of the environment was lent further support by comparative studies of two U.S. farming populations originated from Germany/ Switzerland, the Amish and the Hutterites, who share highly similar genetic background. However, the Amish retains the traditional farming practice with frequent contact with farm animals, whereas the Hutterites embrace modern farming techniques using farm machinery. ...
Article
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Background Asthma is one of the most common chronic diseases in childhood, and the prevalence has been increasing over the past few decades. One of the most consistent epidemiological findings is that children living in a farming or rural environment are protected from development of asthma and allergies, but the protective factors in rural China are not clear. Methods A community‐based, cross‐sectional epidemiological study was performed in a total of 17,587 children aged 5–8 years, 3435 from Hong Kong (urban) and 14,152 from Conghua (rural county in southern China). Asthma and allergic symptoms as well as environmental exposures were ascertained by using a standardized and validated questionnaire. Results The prevalence of current wheeze was significantly lower in rural Conghua than that of urban Hong Kong (1.7% vs. 7.7%, p < 0.001). A lower rate of asthma ever was also reported in rural children compared with their urban counterparts (2.5% vs. 5.3%, p < 0.001). After adjusting for confounding factors, exposure to agricultural farming (adjusted odds ratio 0.74, 95% confidence interval: 0.56–0.97) and poultry (0.75, 0.59–0.96) were the most important factors associated with the asthma‐protective effect in the rural area. Further propensity score‐adjusted analysis indicated that such protection conferred by living in the rural environment was mainly attributable to poultry exposure. Conclusions We confirmed that the prevalence of asthma and atopic disorders was significantly lower in rural children when compared with their urban peers. Exposure to poultry and agricultural farming are the most important factors associated with asthma protection in the rural area.
... Previous studies reported that school children in anthroposophic families have a lower prevalence of IgE-mediated allergies. 18,19 The anthroposophic lifestyle is characterized by changes in several aspects of infant care that have been associated with immune system development. These include home delivery, lower frequency of body washing, prolonged breast feeding, organic diet with live lactobacilli, and restricted use of antibiotics, antipyretics, and vaccinations. ...
... To [18][19][20] particularly to food allergens early in life. 21,28,29 This study revealed that even though all children showed similar immune cell composition at birth, they could be separated into two Population frequencies are shown as a fraction of all cells different from peripheral blood even after the first days of life, 12,13 and this study highlights that the most drastic changes toward a maternal phenotype occur at some point between birth and two years of age, for all cell types except monocytes ( Figure 3). ...
Article
Full-text available
Background Changes in immune cell composition during the immunological window within the first years after birth are not fully understood, especially the effect that different lifestyles might have on immune cell functionality. Methods Peripheral blood mononuclear cells from mothers and their children at birth and at two anvd five years were analyzed by mass cytometry. Immune cell composition and functionality was analyzed according to family lifestyle (anthroposophic and non‐anthroposophic). Results We found no significant differences in the proportions of major immune lineages between anthroposophic and non‐anthroposophic children at each time point, but there were clear changes over time in the proportions of mononuclear leukocytes, especially in B‐cells and T lymphocytes. Phenotypic distances between cord blood and maternal blood were high at birth but decreased sharply the first two years, indicating strong phenotypic convergence with maternal cells. We found that children exhibited similar stimulation responses at birth, but subsequently segregated into two discrete functional trajectories. Trajectory 1 was associated with a decrease in tumor necrosis factor alpha (TNFa) production by CD4⁺ T‐ and NK‐cells, while Trajectory 2 depicted an increase in the production of IL‐2 and interferon gamma (INFg) by T‐cells. In both trajectories, there was an increase in IL‐17A production by T‐cells resulting in prominent differences at five years of age. Conclusions This exploratory study suggests that leukocyte frequencies and cell phenotypes change with age in the same way across all children, while functional development follows one of two discrete trajectories that largely segregate by family lifestyle, supporting the hypothesis that early environmental exposures imprint immune cell function which may contribute to IgE sensitization. Our results also support that the first two years are critical for the environmental exposures to imprint the immune cells. Further studies with larger sample sizes are required to validate our findings.
... 143 Numerous studies conducted in rural areas have found lower incidences of atopic and allergic diseases in children and adults growing up on farms, as compared to growing up in urban environments. 139,[144][145][146][147][148][149][150][151][152][153][154] A high microbial diversity of the house dust was associated with a lower risk of allergic diseases. 154 The most commonly studied microbial agent is endotoxin or lipopolysaccharide, derived from Gram-negative bacteria. ...
Article
Full-text available
Human skin is colonized with skin microbiota that includes commensal bacteria, fungi, arthropods, archaea and viruses. The composition of the microbiota varies at different anatomical locations according to changes in body temperature, pH, humidity/hydration or sebum content. A homeostatic skin microbiota is crucial to maintain epithelial barrier functions, to protect from invading pathogens and to interact with the immune system. Therefore, maintaining homeostasis holds promise to be an achievable goal for microbiome‐directed treatment strategies as well as a prophylactic strategy to prevent the development of skin diseases, as dysbiosis or disruption of homeostatic skin microbiota is associated with skin inflammation. A healthy skin microbiome is likely modulated by genetic as well as environmental and lifestyle factors. In this review, we aim to provide a complete overview of the lifestyle and environmental factors that can contribute to maintaining the skin microbiome healthy. Awareness of these factors could be the basis for a prophylactic strategy to prevent the development of skin diseases or to be used as a therapeutic approach.
... All we know is that previous observations suggest the operation of environment-specific regulatory mechanisms affects the risk of sensitization and the magnitude of specific IgE production. [33,34] Further, different interactions of potential allergens with airway epithelial cells and other cells located within and below the epithelium will affect the outcome of antigen exposure. [35] On the other hand, asthma is a common disease with a complex risk architecture, including both genetic and environmental factors; thus, many polymorphisms may effect on immunological parameters. ...
Article
Full-text available
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com How to cite this article: Hameed RM, Al-Hasnawy HH, Abood HAAN. The age and residence impact on IgE serum level in patients with allergic asthma. Med J Babylon 2024;21:155-60. Abstract Background: Immunoglobulin E (IgE) has a role in mediating allergic reactions and their powerful effector functions, but numerous factors influence its value. Objective: To find any difference in total and specific IgE serum levels at the different age groups and residences. Materials and Methods: Eighty-seven asthmatic children, including 57 males and 30 females with asthma aged between 1 and 16 years old, 32.2% living in rural and 67.8% living in urban, were collected at Kerbala Teaching Hospital for Children. All asthmatic children in this study were subjected to measuring total IgE level using AccuBind IgE ELISA kit, Human Chlamydia pneumoniae IgG using Cpn IgG ELISA kit, and Human C. pneumoniae IgE using Cpn IgE ELISA kit. Results: There was a significant positive linear correlation between age and total IgE level and a significant negative correlation between age and C. pneumoniae IgE in asthmatic children (0.255, P = 0.017,-0.233, P = 0.03, respectively). Further, there was a significant positive linear correlation between total IgE and C. pneumoniae IgE under age controlling (0.225, P = 0.019). In urban residents, the asthmatic children more than eleven years old had a low C. pneumonia IgE serum level (5.845 ± 1.821 ng/L) compared with asthmatic children who lived in rural areas (8.206 ± 2.793 ng/L). Depending on age groups, there was a significant difference (P = 0.047) in C. pneumonia IgE serum levels in asthmatic children who lived in urban areas. Conclusion: C. pneumonia-specific IgE decreased in early adulthood urban asthmatic children.
... Studies have also indicated that the people consuming most organic food have a 25% lower risk of cancer, particularly lymphoma and postmenopausal breast cancer, compared to those who consume the least organic food (Baudry et al., 2018). A range of factors might have influenced the outcomes of these various cohort studies, as organic and conventional consumers differ in lifestyle factors, such as dietary patterns, use of medication and health supplements along with vaccinations, and level of physical activity, all of which may be difficult to factor into cohort studies (Alfvén et al., 2006;Brandt et al., 2013). ...
Article
The growing trend towards organic food consumption (OFC) due to health, environmental, and other concerns necessitates the need for systematic research in this area. Analyzing 783 articles listed in the Scopus database from 1991 to 2022, this systematic study was conducted with the most updated guidelines laid by avid and prominent researchers in the field of bibliometrics to review the evolution of trends and themes in OFC globally. The study synthesized the existing research on OFC and identified gaps in knowledge using performance analysis, science mapping, and content analysis. Purchase intentions, health consciousness, attitudes to OFC, the theory of planned behavior (TPB), green marketing, and environmental concerns emerged as the growing concepts across the themes and clusters in the recent period. Importantly, based on the analyzed literature, the study also maps out possible research topics for future research that could help improve the research trajectory in the OFC field. Overall, the study provides helpful resources for researchers, particularly new scholars, in the field of OFC
... All we know is that previous observations suggest the operation of environment-specific regulatory mechanisms affects the risk of sensitization and the magnitude of specific IgE production. [33,34] Further, different interactions of potential allergens with airway epithelial cells and other cells located within and below the epithelium will affect the outcome of antigen exposure. [35] On the other hand, asthma is a common disease with a complex risk architecture, including both genetic and environmental factors; thus, many polymorphisms may effect on immunological parameters. ...
Article
Full-text available
Background Immunoglobulin E (IgE) has a role in mediating allergic reactions and their powerful effector functions, but numerous factors influence its value. Objective To find any difference in total and specific IgE serum levels at the different age groups and residences. Materials and Methods Eighty-seven asthmatic children, including 57 males and 30 females with asthma aged between 1 and 16 years old, 32.2% living in rural and 67.8% living in urban, were collected at Kerbala Teaching Hospital for Children. All asthmatic children in this study were subjected to measuring total IgE level using AccuBind IgE ELISA kit, Human Chlamydia pneumoniae IgG using Cpn IgG ELISA kit, and Human C. pneumoniae IgE using Cpn IgE ELISA kit. Results There was a significant positive linear correlation between age and total IgE level and a significant negative correlation between age and C. pneumoniae IgE in asthmatic children (0.255, P = 0.017, -0.233, P = 0.03, respectively). Further, there was a significant positive linear correlation between total IgE and C. pneumoniae IgE under age controlling (0.225, P = 0.019). In urban residents, the asthmatic children more than eleven years old had a low C. pneumonia IgE serum level (5.845 ± 1.821 ng/L) compared with asthmatic children who lived in rural areas (8.206 ± 2.793 ng/L). Depending on age groups, there was a significant difference ( P = 0.047) in C. pneumonia IgE serum levels in asthmatic children who lived in urban areas. Conclusion C. pneumonia -specific IgE decreased in early adulthood urban asthmatic children.
... Deux études ont été menées chez des enfants élevés dans des familles anthroposophiques (agriculture biodynamique) et scolarisés selon les principes de la secte de Steiner. La première est une étude transversale comparant les symptômes allergiques déclarés chez 14 893 enfants de 5-13 ans de familles fermières, ou anthroposophiques ou témoins dans 5 pays européens [28]. Les enfants élevés dans des fermes avaient moins de symptômes (rhino-conjonctivite) et de sensibilisation atopique que les témoins de façon significative. ...
... Decreased cell proliferation of cancer cells was observed on extracts of organic strawberries (Olsson et al., 2006). The Parsifal study showed 30 percent less eczema and allergy complaints and less body weight among 14 000 children fed with organic and biodynamic food in five EU countries (Alfven et al., 2006). In animals, organic feed leads to increased fertility (Staiger, 1988) and increased immune parameters (Finamore et al., 2004). ...
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Book
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Alpine regions are characterized by exceptional natural resources, cultural heritage, healthy climate, and long tourism tradition. Tourism is a major component of economic growth, with several employment opportunities, and of great importance for the Alpine regions, with many positive effects on the local and regional population. Natural resources can determine the development of competitive tourism destinations and drive the development of nature-based value chains aimed at enhancing tourists’ health and well-being. Historically, the small size of most enterprises, the difficulties in establishing collaborative relationships between industry operators, and the lack of strategic projects aimed at the use and exploitation of natural resources, have hindered a systematic development of a nature-based health tourism (NHT) value chain. Nowadays, tourist market segments are changing the industry competitiveness with the request for more nature-based experiential programs, integrating both rewarding elements of beauty, relaxation, and regeneration, and more demanding elements such as preventative activities and sports. There is an increasing consciousness of the importance of local environmental and cultural preservation, the search for relax and stress-relieving products, and the overall authenticity of the vacation experience. Beyond lifestyle changes, key trends reshaping the health tourism landscape in Alpine regions include population ageing, climate change, and consequences of the COVID-19 pandemic both in terms of business losses and the need for natural remedies against these virus’s long-term effects. This background challenges health tourism operators to rethink the industry dynamics with a more innovation-driven strategy and business development, as well as facilitation of transnational cooperation among all kinds of actors. These include sectoral and specialized agencies such as destination management organizations, business support organizations, and tourism organizations; regional councils and municipalities in charge of policy-making and tourism strategy development; tourism facilities and companies (especially small- and medium-sized enterprises); universities and research centres that conduct applied research and development within the health tourism sector and related sectors, based on natural resources or health-related issues; interest groups and networks supporting nature-based and sustainable health tourism. Despite the richness of natural resources and health-promoting activities that spread among Alpine regions, the NHT landscape is characterized by innovation spatial fragmentation, lack of access to knowledge, and little transversal cooperation for value creation and sharing. Aimed to address these key territorial challenges, the HEALPS2 project “Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions” was funded in the Priority “Innovative Alpine Space” of the Interreg Alpine Space program. The key objective of the project was to improve the framework conditions for utilizing the Alpine natural health resources by leveraging existing and newly developed NHT products and service chains to enhance access to knowledge and sharing of experiences at a transnational level. The main project activities took place from October 2019 to June 2022 and involved 11 organizations from 6 countries, i.e. Austria, Italy, Slovenia, Germany, France, and Switzerland. The collaboration between the project partners led to the development of a set of innovation practices and digital solutions, properly combined with the latest research results in tourism and health-related issues and the requirements of health tourism stakeholders collected in several events organized at the local and regional level. The vision of the project is to contribute to the positioning of the Alpine Space as a globally attractive health-promoting place, with a virtuous process of value generation and sharing among Alpine assets, actors, and territories. This book incorporates the key knowledge and experiences, in terms of concepts, tools, and practices, developed within the HEALPS2 project, here organized into eight chapters. The content was purposefully organized to dedicate to the core assets for an Alpine NHT industry excellence, i.e. the natural resources and their healing effects; the digital tools enhancing the collection, advanced analytics and spread of data on NHT industry for supporting strategic decision-making; the innovation practices and communication strategies to properly engage the industry stakeholders.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
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Tourism has been one of the most important economic sectors in the Alps for many years. However, not least because of the cuts due to the pandemic, new and innovative approaches are needed to meet current challenges such as climate change, shortage of skilled workers or demographic change in order to make Alpine tourism fit for the future. The topic of health offers great potential in this context. With the KPI approach, therefore, a possible access to a nature-based health tourism with medical evidence is presented, which should support the actors from the tourism practice in the further development of the Alpine tourism. At the same time, the KPI approach also offers possibilities to enable an overall more sustainable development of the Alpine region. This paper places the KPI approach in a larger development framework and explains the underlying analytical system based on selected indicators.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
This work describes the challenges, techniques, and methodologies to develop a digital tool that aims to improve framework conditions and tools for better utilization of Alpine natural resources in health tourism. Starting from the literature analysis and an online survey, the system implemented a comprehensive knowledge base adopted for an ontology-based Decision Support System leveraging on identified Key Performance Indicators (KPIs). Relying on this knowledge, the digital tool provides a list of tailored and customized recommendations for each destination within the Alpine area. This result helps the stakeholders capitalize on the nature-based health tourism potentials of their region in relation to the existence of the natural resources and different target users’ health conditions. This strategic digital tool is developed as a web-based application for destinations’ policy-makers and managers to fill the online survey and receive customized suggestions, recommendations, and insights on how to further exploit their natural resources in order to enhance nature-based health tourism.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
The Alpine space disposes of excellent prerequisites to respond to the increasing demand of nature-based health tourism. Despite a growing scientific knowledge on the manifold benefits of human interaction with Alpine natural resources, the health tourism potential has not yet been fully exploited by Alpine regions. Based on major push and pull factors, the current state of scientific knowledge on the healing potential of nine selected natural Alpine resources is presented and discussed with regard to their health tourism potential. Major research gaps as well as starting points for future studies are demonstrated. In this way, the present work contributes to an applicable knowledge base on the health benefits of Alpine resources to enhance regional innovation capacity in terms of sustainable health tourism development. As tourism regions are increasingly taking evidence-based approaches to health tourism and regional development, the resulting lighthouses will contribute to the positioning of the Alpine space as globally attractive healing environment.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
Participatory stakeholder engagement in strategy-making, for industries such as Nature-based Health Tourism (NHT), enhances the delivery of more useful and applicable strategies, with also higher chances to reach intended goals if compared to conventional top-down planning processes. This chapter describes the methodology identified and carried out in the HEALPS2 project to efficiently reach and engage stakeholders of Alpine NHT and to form a stakeholder group at the transnational level (including the engagement of EU-level ac-tors and networks). Based on the Quadruple Helix concept, the methodology integrates a process of stakeholder engagement and endorsement along three steps; the identification of the key points and the problems to be tackled for a successful stakeholder engagement; and the development of Regional and Transnational Stakeholder Groups that extend to the cooperation with EU-wide networks. Developing health tourism products and service chains, and sustaining them with strategies and policies, is a complex undertaking. The adoption of the stakeholder engagement approaches throughout the HEALPS2 project showed that it is of utmost importance to properly identify, involve and communicate with the stakeholders who effectively complement the success of the project, and its outcomes, in enhancing NHT competitiveness.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
Communication activities play a pivotal role in the management of research projects, especially those involving several partners and stakeholders from different countries. The Interreg Alpine Space HEALPS2 project relies on a transnational and transversal approach to improve the framework conditions and tools for alpine health tourism, and therefore proposes a communication strategy based on specific objectives. These objectives guide the communication activities at an internal and external level, with the latter being declined for different targets and stakeholders. In this Chapter, the communication activities are described, starting from the general and specific objectives-oriented approach, to the local realization. The general strategy and the analysis are illustrated, then are demonstrated through a regional use case—the Parco Regionale Alpe Veglia-Alpe Devero and Parco Regionale Alta Valle Antrona.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
Innovation is considered essential to the growth and long-term sustainability of health tourism companies and destinations. Continuous innovation takes place to improve the industry competitiveness, but especially the tourists’ experience and wellness with new product offerings. This Chapter collects and describes the innovation practices proposed and developed in some pilot regions of the HEALPS2 project consortium. The innovation practices identified in the project can be subdivided into three types, i.e., innovation techniques, innovation supporting tools, and innovative product offerings. All the practices were designed to target several operators of the Nature-based Health Tourism (NHT) industry, from tourism facilities and companies (especially small- and medium-sized enterprises) to regional councils and municipalities in charge of policy-making and tourism strategy development. HEALPS 2 innovation practices and techniques can be purposefully integrated at the regional and local level for a more innovation-driven industry strategy and business development, as well as facilitation of transnational cooperation among key actors, also beyond Alpine regions and NHT destinations.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
Nature-based health tourism is experiencing a resurgence. To determine its potential as a development opportunity for alpine destinations, it is necessary to analyse both the demand and supply side. Two surveys were conducted: a representative survey of the population of six countries of the Alpine Space exploring the perception of the Alps as a healthy destination in general and on the personal assessment of the health effect of natural resources in particular and an exploratory survey of tourism stakeholders in destination management, accommodation and gastronomy as well as (health) tourism services with a focus on the expected economic developments and the relevance of individual target groups for nature-based health tourism. The results demonstrate the need for a strategic development process which aligns perceptions with destination strategy and pre-existing offers. Two potential strategies are briefly outlined: 1. destinations with non-locally specific alpine natural health resources can develop broad tourism experiences for health conditions that occur across society with health a secondary aspect in marketing. 2. destinations featuring locally specific natural health resources with proven evidence can develop offers for a specific condition and are thus able to target a very specific group.
... As early as the late 1990s, Von Ehrenstein and colleagues [41] as well as Riedler and colleagues [42,43] found that farmer's children have a lower prevalence of hay fever, asthma, rhinoconjunctivitis as well as other atopic diseases and concluded that increased exposure to bacterial compounds in stables with livestock prevents the development of allergic disorders in children (level III). These findings could also be reproduced in other authors [see, e.g., [44][45][46][47][48]. There is a solid body of evidence that exposure to a greater variety of environmental microorganisms explains a substantial fraction of the inverse relation between asthma and growing up on a farm [49]. ...
Chapter
Full-text available
The competitiveness of nature-based Health Tourism (NHT) industry, especially in the Alpine regions, is increasingly linked to the sustainability and exploitation of unique natural resources of tourism destinations, which often lack the access to knowledge and networks of stakeholders to improve their offerings. In this sense, the use of digital tools can open up further opportunities to reconsider value offerings and better access different knowledge resources and relationships within the industry network. This Chapter illustrates the collaborative design approach adopted in HEALPS2 for the development of an ontology-based Decision Support System for health tourism destinations. The resulting ontology aims to model the relationships between the available natural resources, the value offerings and the target groups of NHT destinations. Moreover, the Collaborative Design approach foresees the involvement of end-users (i.e. not only tourism destinations, but also the network of stakeholders, and the actual and potential future tourists) as both sources of knowledge and validators of the ontology and its outputs, aiming to inform decision-making processes in a shared knowledge model that leverages on digital tools.
... Well-functioning immune regulation and immune tolerance and low incidence of immune-mediated diseases has been reported to be associated with living next to agricultural areas and green space (Hanski et al., 2012;Kirjavainen et al., 2019;Nurminen et al., 2021). Similarly, people following traditional lifestyles with abundant contacts with environmental microbiota typically have diverse commensal microbiota and low incidences of immune-mediated diseases (Alfven et al., 2006;Kondrashova et al., 2013;Lee et al., 2012;Stein et al., 2016;Williams et al., 2005). On the other hand, agricultural environment may enrich bacteria, such as Thermoactinomyces vulgaris, T. viridis and T. sacchari, that have been associated with inflammatory reactions and eventually hypersensitivity pneumonitis (Nogueira et al., 2019). ...
Article
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Background: According to the biodiversity hypothesis of immune-mediated diseases, lack of microbiological diversity in the everyday living environment is a core reason for dysregulation of immune tolerance and – eventually – the epidemic of immune-mediated diseases in western urban populations. Despite years of intense research, the hypothesis was never tested in a double-blinded and placebo-controlled intervention trial. Objective: We aimed to perform the first placebo-controlled double-blinded test that investigates the effect of biodiversity on immune tolerance. Methods: In the intervention group, children aged 3–5 years were exposed to playground sand enriched with microbially diverse soil, or in the placebo group, visually similar, but microbially poor sand colored with peat (13 participants per treatment group). Children played twice a day for 20 min in the sandbox for 14 days. Sand, skin and gut bacterial, and blood samples were taken at baseline and after 14 days. Bacterial changes were followed for 28 days. Sand, skin and gut metagenome was determined by high throughput sequencing of bacterial 16 S rRNA gene. Cytokines were measured from plasma and the frequency of blood regulatory T cells was defined as a percentage of total CD3 +CD4 + T cells. Results: Bacterial richness (P
... Children growing up on farms have a lower risk of asthma and allergies than children living in the same rural area but not on farms [89,90]. This protective "farm effect" is recognized in many people until adulthood [91]. ...
Article
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Alkaline phosphatase (ALP) is abundant in raw milk. Because of its high heat resistance, ALP negative is used as an indicator of successful sterilization. However, pasteurized milk loses its immune protection against allergy. Clinically, ALP is also used as an indicator of organ diseases. When the activity of ALP in blood increases, it is considered that diseases occur in viscera and organs. Oral administration or injecting ALP will not cause harm to the body and has a variety of probiotic effects. For infants with low immunity, ALP intake is a good prebiotic for protecting the infant’s intestine from potential pathogenic bacteria. In addition, ALP has a variety of probiotic effects for any age group, including prevention and treatment intestinal diseases, allergies, hepatitis, acute kidney injury (AKI), diabetes, and even the prevention of aging. The prebiotic effects of alkaline phosphatase on the health of infants and consumers and the content of ALP in different mammalian raw milk are summarized. The review calls on consumers and manufacturers to pay more attention to ALP, especially for infants with incomplete immune development. ALP supplementation is conducive to the healthy growth of infants.
... Taking organic level in the diets, organic consumers who regularly buy and consume organic food are healthier with markedly less overweight and obesity Eisinger-Watzl et al., 2015) as well as following recommended healthier dietary patterns (Kesse- Baudry et al., 2016aBaudry et al., , 2016b. Other studies reported reduced allergy prevalence in children following an organic diet (Alfven et al., 2006) or a reduced risk of having a metabolic syndrome in adults (Baudry et al., 2017a, b). ...
Chapter
Sustainable diets are those diets with low environmental impacts that contribute to food and nutrition security and to healthy lives for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable, are nutritionally adequate, safe, and healthy, and optimize natural and human resources. (FAO, 2010). This book takes a transdisciplinary approach and considers multisectoral actions, integrating health, agriculture and environmental sector issues to comprehensively explore the topic of sustainable diets. The team of international authors informs readers with arguments, challenges, perspectives, policies, actions and solutions on global topics that must be properly understood in order to be effectively addressed. They position issues of sustainable diets as central to the Earth’s future. Presenting the latest findings, they: • Explore the transition to sustainable diets within the context of sustainable food systems, addressing the right to food, and linking food security and nutrition to sustainability. • Convey the urgency of coordinated action, and consider how to engage multiple sectors in dialogue and joint research to tackle the pressing problems that have taken us to the edge, and beyond, of the planet’s limits to growth. • Review tools, methods and indicators for assessing sustainable diets. • Describe lessons learned from case studies on both traditional food systems and current dietary challenges. As an affiliated project of the One Planet Sustainable Food Systems Programme, this book provides a way forward for achieving global and local targets, including the Sustainable Development Goals and the United Nations Decade of Action on Nutrition commitments. This resource is essential reading for scientists, practitioners, and students in the fields of nutrition science, food science, environmental sciences, agricultural sciences, development studies, food studies, public health and food policy
... In one cross-sectional study, frequent consumption of fermented vegetables, a characteristic of the anthroposophic lifestyle, was correlated with lower prevalence of allergic diseases and positive responses to objective tests of atopy in children [144]. The lower prevalence of current rhinoconjunctivitis symptoms, atopic eczema symptoms, and atopic sensitization was also reported among children attending Steiner schools leading an anthroposophic lifestyle in the PARSIFAL study [145]. Similar findings have also been found in the prospective birth cohort Assessment of Lifestyle and Allergic Disease During Infancy (ALADDIN), which demonstrated that leading an anthroposophic lifestyle was associated with a decreased prevalence of food allergen sensitization and episodes of wheeze reported by parents, but not eczema [146]. ...
Article
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In the last few decades, a dramatic increase in the global prevalence of allergic diseases and asthma was observed. It was hypothesized that diet may be an important immunomodulatory factor influencing susceptibility to allergic diseases. Fermented food, a natural source of living microorganisms and bioactive compounds, has been demonstrated to possess health-promoting potentials and seems to be a promising strategy to reduce the risk of various immune-related diseases, such as allergic diseases and asthma. The exact mechanisms by which allergic diseases and asthma can be alleviated or prevented by fermented food are not well understood; however, its potential to exert an effect through modulating the immune response and influencing the gut microbiota has been recently studied. In this review, we provide the current knowledge on the role of diet, including fermented foods, in preventing or treating allergic diseases and asthma.
... Авторы обнаружили, что у детей, живущих в сельскохозяйственной среде, частота сенной лихорадки, астмы и экземы значительно снижена по сравнению с детьми, проживающими в городских районах. Аналогичная взаимосвязь была продемонстрирована также по данным исследований PARSIFAL [22] и GABRIELA [23], которые подтвердили предыдущие наблюдения о том, что дети, живущие на фермах, имеют сниженный уровень аллергических заболеваний по сравнению с городскими детьми. Хотя в большинстве подобного рода исследований основное внимание уделялось влиянию постнатального воздействия окружающей среды, сегодня все больше доказательств того, что важное значение может иметь и предродовое воздействие [24]. ...
Article
The review article presents current data on the possible connection between the occurrence of allergies and disorders in the intestinal microbiota. The role of the intestinal microbiota in the development of the immune system of a child, as well as the maintenance of its immune tolerance, is discussed. Factors whose effects can be associated with changes in the intestinal microbiota and the development of allergic diseases are considered.
... The "hygiene hypothesis" proposed that respiratory infections associated with overcrowding and unhygienic conditions confer an element of protection on hay fever and atopy. 51 The hypothesis has been pushed forward by various comparative studies conducted in different regions across the globe showing that children living in a rural/farming environment had much lower prevalence of allergies than those in urban areas, [52][53][54][55][56][57][58] representing one of the strongest and most consistent protective factors against development of allergic diseases. Two main pillars of the "farm effect" in central Europe are exposure to livestock and consumption of raw farm milk. ...
Article
Full-text available
Asia-Pacific is a populous region with remarkable variations in socioeconomic development and environmental exposure among countries. The prevalence rates of asthma and allergic rhinitis appear to have recently reached a plateau in Western countries, whereas they are still increasing in many Asian countries. Given the large population in Asia, even a slight increase in the prevalence rate will translate into an overwhelming number of patients. To reduce the magnitude of the increase in allergic diseases in next few decades in Asia, we must understand the potential factors leading to the occurrence of these disorders and the development of potential preventive strategies. The etiology of allergic disorders is likely due to complex interactions among genetic, epigenetic, and environmental factors for the manifestations of inappropriate immune responses. As urbanization and industrialization inevitably progress in Asia, there is an urgent need to curtail the upcoming waves of the allergy epidemic. Potentially modifiable risk exposure, such as air pollution, should be minimized through timely implementation of effective legislations. Meanwhile, re-introduction of protective factors that were once part of the traditional farming lifestyle might give new insight into primary prevention of allergy.
... According to Alfvén et al. 4 Kummeling et al. 5 several studies have examined the possible human health effects of organic diets through observational data from consumers beyond the chemical composition of foods. A few studies suggest that the consumption of organic foods can be associated with a lower risk of allergies and eczema in infants. ...
... Atopic diseases have increased in the last decades [121], especially in developed countries. Genetic and environmental factors have a crucial role in this condition; in this regard, the "hygiene hypothesis" [122] assumes that reduced early life exposure to factors contributing to the modulation and maturation of the immune system, as the contact and infection with different microbes could increase the risk of developing atopic diseases [123]. As it is known, the gut microbiota is one of the most important contributors to the development and maintenance of immune system functions. ...
Article
Full-text available
Bifidobacteria are among the predominant microorganisms during infancy, being a dominant microbial group in the healthy breastfed infant and playing a crucial role in newborns and infant development. Not only the levels of the Bifidobacterium genus but also the profile and quantity of the different bifidobacterial species have been demonstrated to be of relevance to infant health. Although no definitive proof is available on the causal association, reduced levels of bifidobacteria are perhaps the most frequently observed alteration of the intestinal microbiota in infant diseases. Moreover, Bifidobacterium strains have been extensively studied by their probiotic attributes. This review compiles the available information about bifidobacterial composition and function since the beginning of life, describing different perinatal factors affecting them, and their implications on different health alterations in infancy. In addition, this review gathers exhaustive information about pre-clinical and clinical studies with Bifidobacterium strains as probiotics in neonates.
... For example, a study of Swedish children found significantly higher risk of allergic conditions among those from public schools than for those at nearby Steiner schools catering to families that emphasized a biodynamic, vegetablerich organic diet (Alm, 1999). Another comparison, involving almost 15,000 European children, found those from public schools who ate more conventional diets had higher incidences of asthma and food allergies (Alfven et al., 2006). A pair of Danish studies reported sperm counts were highest among men who consumed the most organic produce and lowest among those who consumed only conventional produce (Jensen et al., 1996;Juhler et al., 1999). ...
Article
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Controversy has long surrounded the question of nutritional differences between crops grown organically or using now-conventional methods, with studies dating back to the 1940s showing that farming methods can affect the nutrient density of crops. More recent studies have shown how reliance on tillage and synthetic nitrogen fertilizers influence soil life, and thereby soil health, in ways that can reduce mineral micronutrient uptake by and phytochemical production in crops. While organic farming tends to enhance soil health and conventional practices degrade it, relying on tillage for weed control on both organic and conventional farms degrades soil organic matter and can disrupt soil life in ways that reduce crop mineral uptake and phytochemical production. Conversely, microbial inoculants and compost and mulch that build soil organic matter can increase crop micronutrient and phytochemical content on both conventional and organic farms. Hence, agronomic effects on nutritional profiles do not fall out simply along the conventional vs. organic distinction, making the effects of farming practices on soil health a better lens for assessing their influence on nutrient density. A review of previous studies and meta-studies finds little evidence for significant differences in crop macronutrient levels between organic and conventional farming practices, as well as substantial evidence for the influence of different cultivars and farming practices on micronutrient concentrations. More consistent differences between organic and conventional crops include that conventional crops contain greater pesticide levels, whereas organically grown crops contain higher levels of phytochemicals shown to exhibit health-protective antioxidant and anti-inflammatory properties. Thus, part of the long-running controversy over nutritional differences between organic and conventional crops appears to arise from different definitions of what constitutes a nutrient—the conventional definition of dietary constituents necessary for growth and survival, or a broader one that also encompasses compounds beneficial for maintenance of health and prevention of chronic disease. For assessing the effects of farming practices on nutrient density soil health adds a much needed dimension—the provisioning of micronutrients and phytochemicals that support human health.
... 20,34,35 The OR of 0.49 in our study was similar in magnitude to that reported in studies from suburban Europe (OR 0.49) and alpine areas (OR 0.74). 36,37 The childhood farming environment is related to higher expression levels of innate immunity genes and protects against asthma development during childhood. 21 In an earlier study, long-term and early-life exposure to stables and farm milk was associated with the highest protective effect against asthma development in children. ...
Article
Full-text available
Purpose Asthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis. Methods A cross-sectional population-based study was carried out with subjects aged 20–69 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (0–11 years), intermediate diagnosis (12–39 years), and late diagnosis (40–69 years). Results The prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, ex-smoker, occupational exposure, and BMI ≥ 30 kg/m² were associated with a higher likelihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87–1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12–4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30–0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47–1.18). Conclusion Odds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late.
Article
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Recent studies have provided compelling evidence to suggest that various environmental factors play a significant role in the development of food allergies. As our society experiences rapid economic growth, increased urbanization, and a shift towards a more Westernized diet, the incidence of food allergies is also on the rise and the pattern is gradually evolving. This review will delve into the changes in the epidemiology of food allergies within the Asia‐Pacific region and the various dietary practices and factors that are postulated to play a role in the rise in food allergies over the years. Although there have been important advancements in the field of food allergies, there are still numerous uncertainties regarding the intricate relationship between diet and food allergies. Specifically, the role of epigenetic factors in influencing the susceptibility to food allergies, as evidenced by studies that assessed the impact of migration and rural–urban dynamics, is not fully understood. Addressing this knowledge gap presents an opportunity to develop more effective prevention and treatment strategies that could greatly benefit individuals living with food allergies. image
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In recommendations for prevention, one has to differentiate between primary, secondary, and tertiary prevention. Primary prevention is relevant for the whole population; for allergy.This only includes breastfeeding for up to 4 months with some evidence. If breastfeeding is not possible, hypoallergenic formula can be used. Also, unsaturated fatty acids, especially omega 3, may be helpful like Mediterranean diet. There is no clear role for pro- or prebiotics. There is some evidence that preventive use of emollients in high-risk infants decreases the risk to develop atopic eczema, but this could not be verified in further trials. Secondary prevention is indicated when there is evidence of house dust-induced exacerbations. In these cases, house dust mite avoidance using encasings may be recommended.Tertiary prevention includes rehabilitation in specialized clinics with climatic benefits like high altitude, e.g., Davos/Switzerland or sea climate on the North Sea Islands or at the Dead Sea.The complex pathophysiology of atopic eczema with the considerable diversity of symptoms, clinical courses, and pathogenetic mechanisms in various patients makes information transfer mandatory. Therefore, educational programs such as “Eczema School” have been developed and are used in a standardized and quality-controlled fashion; in some countries like Germany, they are reimbursed by insurance.KeywordsPrimary preventionBreastfeedingHypoallergenic formulaClimate therapyEducational program eczema school
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The prevalence of atopic dermatitis/eczema has increased during the last decades; however, the diseases probably have been around for four centuries. The term “eczema” was first used by the Greek Aetius from Amida in the sixteenth century. In scientific dermatology, eczema was introduced by Robert Willan in 1808. When Coca and Cooke in 1923 created the term “atopy” for a familiar occurrence of respiratory allergies, eczema was only included in 1933 by Wise and Sulzberger as atopic dermatitis or atopic eczema.The definition of eczema means a noncontagious epidermo-dermitis with typical clinical and dermato-histological signs and comprises irritative-toxic and allergic contact dermatitis, but also other forms like seborrheic dermatitis and nummular eczema. Today the terms “atopic eczema” and “atopic dermatitis” are used equivalently. Among lay people, eczema is better understood as a special form of skin inflammation compared to the rather vague term “dermatitis.” With regard to “atopic,” this term classically reflects elevated immunoglobulin E levels which are frequently observed in atopic eczema. However, not in every patient IgE plays a pathogenetic role; furthermore, there are patients with severe eczema without IgE elevations. Therefore, the distinction between “extrinsic” (IgE-associated) or “intrinsic” (non-IgE associated) eczema has been found valuable. Thus, the definition of atopy should not only focus on IgE production but rather read as follows:Atopy is the familial tendency to develop certain diseases (rhinoconjunctivitis, asthma, eczema) on the basis of hypersensitivity of skin and mucous membranes against environmental substances associated with increased IgE production and/or epithelial barrier dysfunction.KeywordsAtopyDermatitisEczemaHistoryTerminology
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Objectives: The purpose of this study was to examine the association between farm exposures and asthma and allergic disease in children while also highlighting the experiences of non-farm rural children. Methods: This was a cross-sectional analysis of data collected from across the province of Saskatchewan, Canada in 2014. Surveys were completed by parents of 2275 rural dwelling children (farm and non-farm) aged 0 to 17 years within 46 rural schools. Questionnaires were distributed through schools for parents to complete. Results: Asthma prevalence was 7.6%, of which 29.5% of cases were allergic. After adjustment for potential confounders, home location (farm vs non-farm) and other farm exposures were not associated with asthma and asthma phenotypes. Those who completed farm safety education were more likely to have asthma (11.7% vs. 6.7%; p = .001) compared to children without asthma. In sub-analyses among 6-12-year-old children, boys were more likely to have asthma (non-allergic) and use short-acting beta-agonists compared to girls. Doing farm work in the summer was associated with an increased risk of asthma [adjusted OR (aOR) = 1.71 (1.02-2.88); p = .041]. Doing routine chores with large animals was associated with an increased risk of asthma [aOR = 1.83 (1.07-3.15); p = .027] and allergic asthma [aOR = 2.37 (95%CI = 1.04-5.40); p = .04]. Conclusion: The present study showed that the prevalence of asthma and asthma phenotypes were similar between farm and non-farm rural children. There did not appear to be differential involvement in farming activities between those with and without asthma although those with asthma had more training suggesting possible attempts to mitigate harm from farm exposures.
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In 1989, a short paper entitled “Hay fever, hygiene and household size” observed that British children from larger families were less likely to develop hay fever and suggested that this could be because early exposure to infection prevents allergy. This sibship size association for hay fever, since replicated many times in Britain and other affluent countries and confirmed by objective measures of atopy, prompted what has come to be known as the “hygiene hypothesis for allergy”, although that term was not specifically used in the 1989 paper. The present paper reviews the historical roots of the “hygiene hypothesis” and charts its development over more than 30 years. Initial scepticism among immunologists turned to enthusiasm in the mid-1990s as the Th1/Th2 paradigm for allergic sensitisation emerged from animal experiments and the concept of “immunological old friends” became popular from the early 2000s. From the late 1990s, observations of reduced allergy risk among children of anthroposophic families and those brought up on farms suggested that the sibship size effects formed part of a broader range of “hygiene-related” determinants of allergy. Children from large families with farming exposure have approximately sixfold reduction in prevalence of hay fever, indicating the potential strength and epidemiological importance of these environmental determinants. During the 21st century, a wide range of specific microbial, environmental and lifestyle factors have been investigated as possible underlying mechanisms, but sadly none have emerged as robust explanations for the family size and farming effects. Thus, while the “hygiene hypothesis” led to a fundamental reappraisal of our relationship with our microbial environment and to the concept that early exposure, rather than avoidance, is beneficial for developing a healthy immune system, the underlying mechanism for variations in allergy prevalence with family size remains, in Churchillian terms, “a riddle wrapped in a mystery inside an enigma”.
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This chapter discusses the research on the influence of the environment of a livestock farm in the protection against the occurrence of allergic diseases during the life of an individual. It was the observation of an unprecedented increase in allergic diseases in the European, American and Japanese populations after Second World War that precipitated the implementation of research in these areas. Since the 1990s, a large number of cross‐sectional epidemiological studies have supplemented the initial observations of the 1980s. The combination of these epidemiological results gave rise to the explanatory hypothesis of “hygiene”, capable of accounting for the observations by resituating them in the immunological concepts of the time. As in the population‐based studies, it was the observation of protection by raw milk consumption that was also the most consistent finding in the analyses from the Protection Against Allergy: Study in Rural Environments cohort.
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Rationale: In murine models, microbial exposures induce protection from experimental allergic asthma through innate immunity. Objectives: Our aim was to assess the association of early life innate immunity with the development of asthma in children at risk. Methods: In the PASTURE farm birth cohort, innate T-helper cell type 2 (Th2), Th1, and Th17 cytokine expression at age 1 year was measured after stimulation of peripheral blood mononuclear cells with LPS in n = 445 children. Children at risk of asthma were defined based on single-nucleotide polymorphisms at the 17q21 asthma gene locus. Specifically, we used the SNP rs7216389 in the GSDMB gene. Wheeze in the first year of life was assessed by weekly diaries and asthma by questionnaire at age 6 years. Measurements and Main Results: Not all cytokines were detectable in all children after LPS stimulation. When classifying detectability of cytokines by latent class analysis, carrying the 17q21 risk allele rs7216389 was associated with risk of wheeze only in the class with the lowest level of LPS-induced activation: odds ratio (OR), 1.89; 95% confidence interval [CI], 1.13-3.16; P = 0.015. In contrast, in children with high cytokine activation after LPS stimulation, no association of the 17q21 risk allele with wheeze (OR, 0.63; 95% CI, 0.29-1.40; P = 0.258, P = 0.034 for interaction) or school-age asthma was observed. In these children, consumption of unprocessed cow's milk was associated with higher cytokine activation (OR, 3.37; 95% CI, 1.56-7.30; P = 0.002), which was in part mediated by the gut microbiome. Conclusions: These findings suggest that within the 17q21 genotype, asthma risk can be mitigated by activated immune responses after innate stimulation, which is partly mediated by a gut-immune axis.
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The prevalence of allergic disorders has been increasing globally, and it may be useful to identify the modifiable factors associated with it. Diet has been identified as one possible lifestyle factor implicated in the pathogenesis of allergic diseases. The goal of this study was to evaluate the associations between dietary patterns and the presence of allergies in a group of young women in eastern Iran. In all, 181 female students were enrolled. Screening for presence of allergic diseases, including allergic rhinitis (AR), asthma and eczema, was performed by an expert allergist. Information about dietary intake was collected using a validated 65-item food frequency questionnaire. Exploratory factor analysis was used to evaluate the relationships between food/nutrition variables. Serum immunoglobulin (Ig)E levels were significantly higher in the group in the third tertile (highest adherence) for a Western dietary pattern compared to the group in the first tertile (lowest adherence). The multivariate odds ratio for presence of allergic rhinitis (AR) was 2.5 (95% CI:1.1-5.1) for the highest compared to lowest tertile of the Western dietary pattern score. However, no significant relationship was found between a traditional dietary pattern and AR, asthma or eczema. Our findings indicate a potential role in the development of AR of the Western dietary pattern, which is characterized by high intake of dairy products, snacks, nuts and sugar. Since diet is a modifiable factor, the relationship between AR and a Western dietary pattern may have clinical implications, particularly in subjects with other risk factors for developing AR.
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Allergic diseases are an increasing global burden. Epidemiological and in vivo studies showed that farming environments could protect from allergic asthma. Studies explaining this protective effect mainly focused on the influence of chemical compounds in the molecular size range of proteins and endotoxins. Our study aimed at deciphering the possible role of small-sized semi-volatile organic compounds (SVOCs) of farming aerosols in immunomodulation processes. Bronchial epithelial BEAS-2B cells were exposed to aerosol extracts of particulate matter (PM2.5) from farming environments. These cell exposures revealed a decisive effect of the smaller sized fraction (< 3 kDa) compared to extracts including the larger sized fraction. We demonstrated that smaller compounds can induce regulations of inflammatory and allergy-related genes including interleukin-8, xanthine dehydrogenase and toll-like receptor 2 (TLR2). Additionally, we performed a comprehensive chemical investigation of two typical farming aerosols (cow vs. sheep) by applying comprehensive gas chromatography coupled to time-of-flight mass spectrometry. We were able to identify several SVOCs characteristic for the protective cow sheds environment including four key components. Cell exposure with the two farming extracts showed a distinct regulation of the E3 ubiquitin ligase PELI2 gene and TLR2 by cow shed extracts. Finally, the regulation of TLR2 corresponded to the regulation that was observed after exposing cells to an artificial mixture of the four key components identified in the cow sheds. In summary, we were able to demonstrate the importance of smaller particle-bound SVOCs found in farming environments concerning their possible contribution to a protective farm effect.
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Organic farming is an environmentally, economically and socially accepted way to produce food. This review scrutinizes various facets of the practice including its impact on the environment, international markets, and local as well as global food security. First-hand knowledge throughout India and the world was evaluated the various strategies and policies implemented for organic agriculture in India. Scenarios depicted here represent millions of people from all social and economic backgrounds who have embraced this agrarian method ensuring the integrity of food. Since organic farming depends on animal manures, off-farm organic wastes, crop residues, green manures, and bio-fertilizers, the question arises whether the availability of these organic feed materials is sufficient to support widespread organic farming in India. In total, these sources could supply 7.04 Mt. of primary nutrients in India, while in the long-term, organic farming could contribute to food security by harmonizing population growth, food grain production, fertilizer consumption, and prevent or minimize soil nutrient depletion. Municipal solid waste compost and sewage water are being increasingly employed in organic agriculture and very large amounts of organic residues and pollutants are added to the soil. Given this, the prospects of organic agriculture to help solve environmental problems need to be researched in more detail. Soil C (carbon) sequestration by municipal solid waste compost and sewage water may to some extent stop environmental degradation. Primarily, organic farming could boost the quality of food by enhancing protein, vitamins, minerals, etc. Soil health and ecological functions such as biomass production, biodiversity maintenance, environmental protection, etc., which occur in organic farming could also be maintained or improved. In this way, it is possible for climatic aberrations could be mitigated or alleviated. However, policies should be developed for proper utilization of bio-waste, integrated farming approaches with organics, prioritizing areas and different kinds of organic farming, better pest management involving bio-pesticides, strengthening the domestic market for organic produce, farmer-to-farmer communication, etc. Our assessment found that organic farming has huge potential for contributing to food security, risk mitigation, etc., in India. Organic farming could also address many of the sustainable development goals directly, namely 3, 5, 6, 11, 12, 13, 14, 15 and 16. However, future research should address areas like: (a) C sequestration and critical C input for organic farming; (b) dynamics, biology and biochemistry of nutrient cycles; (c) impact of the exposure of organic farming to contaminants; and (d) producing higher quality food crops.
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Lower prevalence rates of allergic diseases in rural as compared with urban populations have been interpreted as indicating an effect of air pollution. However, little is known about other factors of the rural environment which may determine the development of atopic sensitization and related diseases. The authors tested the hypothesis that children growing up on a farm were less likely to be sensitized to common aerollergens and to suffer from allergic diseases than children living in the same villages but in nonfarming families. Three age groups of schoolchildren (6-7 years, 9-11 years, 13-15 years) living in three rural communities were included in the analyses. An exhaustive questionnaire was filled in by 1620 (86.0%) parents. A blood sample was provided by 404 (69.3%) of the 13-15 year olds to determine specific IgE antibodies against six common aeroallergens. Farming as parental occupation was reported for 307 children (19.0%). After adjustment for potential covariates such as family history of asthma and allergies, parental education, number of siblings, maternal smoking, pet ownership, indoor humidity and heating fuels, farming as parental occupation was significantly associated with lower rates of sneezing attacks during pollen season (adjusted OR 0.34, 95% CI 0.12-0.89) and atopic sensitization (adjusted OR 0.31, 95% CI 0.13-0.73) whereas the association with wheeze (adjusted OR 0.77 95% CI 0.38-1.58) and itchy skin rash (adjusted OR 0.86, 95% CI 0.49-1.50) was not statistically significant. The risk of atopic sensitization was lower in children from full-time farmers (adjusted OR 0.24, 95% CI 0.09-0.66) than from part-time farmers (adjusted OR 0.54, 95% CI 0.15-1.96). Factors directly or indirectly related to farming as parental occupation decrease the risk of children becoming atopic and developing symptoms of allergic rhinitis.
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Increased prevalence of atopic disorders in children may be associated with changes in types of childhood infections, vaccination programmes, and intestinal microflora. People who follow an anthroposophic way of life use antibiotics restrictively, have few vaccinations, and their diet usually contains live lactobacilli, which may affect the intestinal microflora. We aimed to study the prevalence of atopy in children from anthroposophic families and the influence of an anthroposophic lifestyle on atopy prevalence. In a cross-sectional study, 295 children aged 5-13 years at two anthroposophic (Steiner) schools near Stockholm, Sweden, were compared with 380 children of the same age at two neighbouring schools in terms of history of atopic and infectious diseases, use of antibiotics and vaccinations, and social and environmental variables. Skin-prick tests were done for 13 common allergens, and we took blood samples from children and their parents for analysis of allergen-specific serum IgE-antibodies. At the Steiner schools, 52% of the children had had antibiotics in the past, compared with 90% in the control schools. 18% and 93% of children, respectively, had had combined immunisation against measles, mumps, and rubella, and 61% of the children at the Steiner schools had had measles. Fermented vegetables, containing live lactobacilli, were consumed by 63% of the children at Steiner schools, compared with 4.5% at the control schools. Skin-prick tests and blood tests showed that the children from Steiner schools had lower prevalence of atopy than controls (odds ratio 0.62 [95% CI 0.43-0.91]). There was an inverse relation between the number of characteristic features of an anthroposophic lifestyle and risk of atopy (p for trend=0.01). Prevalence of atopy is lower in children from anthroposophic families than in children from other families. Lifestyle factors associated with anthroposophy may lessen the risk of atopy in childhood.
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A protective effect of infections in early life might explain the firmly reported finding of an inverse association between atopic disorders and large sibships. To study the effect of childhood farm, rural non-farm and urban environment, as well as family size and other factors on the occurrence of asthma, wheezing and atopic disorders up to young adulthood. Data on lifetime prevalence of physician-diagnosed asthma, allergic rhinitis and/or allergic conjunctivitis, atopic dermatitis, as well as self-reported episodic wheezing from 10 667 Finnish first-year university students aged 18-24 years were collected by a postal questionnaire. Associations of lifetime prevalence of the diseases with living on a farm, in a rural non-farm and urban environment during childhood were estimated by logistic regression analysis. Adjustment was made for potential confounding by gender, parental atopy, parental education, number of older siblings, day care outside the home and passive smoking. The childhood farm environment independently reduced the risk for physician-diagnosed allergic rhinitis and/or allergic conjunctivitis (adjusted odds ratio 0.63, 95% CI 0.50-0.79, P < 0.001), and for diagnosed asthma and episodic wheezing analysed together (OR 0.71, 95% CI 0.54-0.93, P < 0.05), but not for atopic dermatitis during lifetime. Urban childhood environment did not show independent increased risk when compared with rural non-farm residence. The inverse association of sibship size with the occurrence of allergic rhinitis and/or allergic conjunctivitis was found among subjects with one (OR 0.86, 95% CI 0.77-0.96, P < 0.01) or at least four older siblings (OR 0.47, 95% CI 0.26-0.84, P < 0.05). Childhood farm environment seems to have a protective effect against allergic rhinitis and/or conjunctivitis, and more weakly against asthma and wheezing irrespective of family size. Environmental exposure to immune modulating agents, such as environmental mycobacteria and actinomycetes, favouring manifestation of a nonatopic phenotype could explain the finding.
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In some studies, the prevalence of hay fever and asthma has been found to be lower in children from rural areas than in children from an urban environment. We hypothesized that living on a farm might be protective against development of allergic sensitization and allergic diseases. In a cross-sectional survey, parents of 2283 children aged 8-10 years from a mostly rural area in Austria answered a standardized questionnaire on allergic diseases and environmental factors. 1137 children performed a skin prick test to seven local allergens. The prevalence of hay fever (3.1 vs 10.3%, P = 0.0002), asthma (1.1 vs 3.9%, P = 0.017) and a positive skin prick reactivity to at least one of the common local allergens (18.8 vs 32.7%, P = 0. 001) was significantly lower in children living on a farm than in children from a non-farming environment. In a multivariate logistic regression model, adjusting for genetic background, parent education, living and housing conditions and dietary factors did not change the odds ratio for the association of farming and allergic sensitization. Only after including 'regular contact with livestock and poultry' into the model did the odds ratio change significantly (cOR 0.48 95% CI 0.30-0.75 to aOR 0.75 95% CI 0.37-1.52) indicating an association between regular contact with farm animals and reduced risk of atopic sensitization. Possible explanations for the lower prevalence of hay fever, asthma and allergic sensitization in children living on a farm might be the development of immunotolerance or the stimulation of TH1 cells and suppression of TH2 cells by increased exposure of farm children to microbial antigens in the stables or farmhouses.